the psychology of health and health care - pearson n. cox simon fraser ... diabetes 189 diabetes and...

the psychology of health and health care

A CAnAdiAn PersPeCtive FiFth edition

GAry PooleUniversity oF British ColUmBiA

deBorAh hUnt mAthesonvAnCoUver islAnd University

dAvid n. Coxsimon FrAser University

Toronto

A01_POOL8273_05_SE_FM.indd 1/8/15 7:03 PM user /204/PHC00178/9780133098273_POOLE/POOLE_PSYCHOLOGY_OF_HEALTH_AND_HEALTH_CARE5_SE_ ...

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Library and Archives Canada Cataloguing in Publication

Poole, Gary, 1950–, author The psychology of health and health care : a Canadian perspective / Gary Poole (University of British Columbia), Deborah Hunt Matheson (Vancouver Island University), David N. Cox (Simon Fraser University).—Fifth edition.

Includes bibliographical references and index.ISBN 978-0-13-309827-3 (pbk.)

1. Medicine and psychology—Textbooks. 2. Medical care—Psychological aspects—Textbooks. I. Matheson, Deborah Hunt, 1966–, author II. Cox, David Neil, 1947–, author III. Title.

R726.7.P66 2015 610.1'9 C2014-908508-7

ISBN 13: 978-0-13-309827-3


For our families:

Marsha, Colleen, and Graeme Poole

Wyatt Matheson

Susan, Kelsi, Kieran, and Dylan Cox


v

Brief ContentsPreface x

Chapter 1 Welcome to Health Psychology 1

Part 1 The Connections between Our Physical and Psychological Worlds

Chapter 2 Stress and Coping 25

Chapter 3 Psychoneuroimmunology 51

Part 2 The Psychology of Wellness and Illness

Chapter 4 Health Communication 76

Chapter 5 Health and Physical Activity 106

Chapter 6 Health-Compromising Behaviours 135

Chapter 7 Chronic and Life-Threatening Illnesses 176

Chapter 8 Pain 206

Chapter 9 The World of Health Care: Places, Procedures, and People 241

Part 3 Bigger Pictures: The Health of Populations

Chapter 10 From One to Many: Health on a Large Scale 279

Chapter 11 Health Promotion 302

Focused Modules FM-1

For Your Reference: Systems of the Body 333

Index 395


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ContentsPreface xAcknowledgements xiiiAbout the Authors xiv

1 Welcome to Health Psychology 1What Is Health Psychology? 2The Roots and Branches of Health Psychology 3The Early Stages of Health Psychology: Applying the Principles of Behaviourism to Health 3Health Psychology Expands to Include Cognition and Personality Factors 5More Attention Is Paid to the Ways People Cope 6The Introduction of Psychoneuroimmunology: Finding Links between Psychological and Biological Processes 6Summary 7The Birth of Health Psychology 7Changing Profiles of Illness and Health in Canada 7Multiple Perspectives Are Needed to Understand Health and Health Statistics 9Health Psychology Today 10The Biopsychosocial Approach to Health 10Prominent Theories in Health Psychology 12Working in Health Psychology 22Clinical and Counselling Psychologists Working in Health Psychology 22Research Careers in Health Psychology 23Chapter Summary 23

Part 1 The Connections between Our Physical and Psychological Worlds

2 Stress and Coping 25Issues of Definition 26The Physiology of Stress 30The General Adaptation Syndrome 32Cognitive Transactional Models 34The Role of Personality in Stress and Coping 37Coping 39East and West: Now the Twain Shall Meet 43Relaxation 45Behaviour Therapy and Cognitive Therapy 46

The Relaxation Responses: A Personal Guide 48Chapter Summary 50

3 Psychoneuroimmunology 51The Importance of PNI to Health Psychology 52How Immune-System Functioning Is Measured in PNI Research 53Counting Cells to Measure Immunocompetence 53Functional Tests of Immunocompetence: Measuring Cells in Action 54Methodological Issues in the Measurement of Immune-System Function 55Research in PNI: Providing Evidence for a Biological Link between Psychology and Health 57The Effect of Stress on Immune Functioning 58The Effect of Depression on Immune Functioning 64Biological Mechanisms to Explain Why Psychological States Affect the Immune System 73Chapter Summary 75

Part 2 The Psychology of Wellness and Illness

4 Health Communication 76Physician-Patient Interaction 78Basic Models of Physician-Patient Interaction 78Physician-Patient Communication 82Adhering to Medical Advice 92Assessing Adherence 92Frequency and Cost of Non-Adherence 93What Factors Predict Adherence? 94Improving Patient Adherence 96Dr. Google: Health and the Internet 100Health-Related Resources Available on the Internet 100Assessing the Quality of Health Information on the Internet 102Implications for Patient-Physician Relationships 103Chapter Summary 105


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5 Health and Physical Activity 106The Nature of Physical Activity 108Physical Activity and the Five Components of Health 112Levels of Physical Activity 112The Five Forms of Physical Activity 114Psychological Benefits of Physical Activity 115Physical Activity and Sense of Self 116Physical Activity and Cognitive Functioning 119Physical Activity and Mood 120Physical Benefits of Physical Activity 122Adherence to Physical Activity 124Psychological Factors Affecting Performance in Exercise and Sport 126Relaxation 128Self-Talk 128Imagery 129Goal Setting 130Mindfulness and Acceptance-Based Interventions 131Physical Activity and Injury 132Chapter Summary 134

6 Health-Compromising Behaviours 135Substance Abuse 136Smoking 136Alcohol Use 147Illicit Drug Use 153Unsafe Sexual Behaviours 157Obesity 158Biological Factors That Contribute to Obesity 162Psychosocial Factors That Contribute to Obesity 163Sociocultural Factors That Contribute to Obesity 163Prevention and Treatment of Obesity 164Eating disorders 168Biological, Cultural, and Psychological Contributors to Eating Disorders 170Treatment for Eating Disorders 171Chapter Summary 174

7 Chronic and Life-Threatening Illnesses 176Cancer 178Some Statistics 178Illness Burden for Cancer 179Physical Problems 179Psychological Distress 180

Cancer Treatment 182Helping People Cope with Cancer 186Diabetes 189Diabetes and Psychological Distress 190Helping People Cope with Diabetes 192Diseases of the Cardiovascular System 192Cardiovascular Disease and Psychological Distress 193Helping People Cope with Cardiovascular Disease 194HIV and AIDS 195HIV/AIDS and Psychological Distress 197Helping People Cope with HIV and AIDS 197A Final Word about Our Discussion of HIV and AIDS 198Other Chronic Conditions 199Quality of Life 199The Tradeoff between Duration and Quality of Life 200Quality of Life as a Subjective Phenomenon 201Death and Dying 202Patients’ Reactions to Death 202Bereavement and Grief 204Chapter Summary 204

8 Pain 206The Significance of Pain 208Pain Perception 209Theories of Pain 210Gate Control Theory 210Neuromatrix Theory 211Neurochemical Basis of Pain and Pain Inhibition 211Acute versus Chronic Pain 213Psychosocial Factors and Pain 216Gender Differences 216Cultural Differences 219The Measurement of Pain 220Psychophysiological Measures 220Behavioural Assessment 220Self-Reports of Pain 221Assessing Pain in Infants and Children 225Assessing Pain in Older Adults 226Pain Control Techniques 227Pharmacological Control of Pain 227Surgical Control of Pain 228Transcutaneous Electrical Nerve Stimulation 229Acupuncture 230Physical Therapy 230


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Massage 231Relaxation 232Distraction 233Hypnosis 236Multidisciplinary Pain Management Programs 238Chapter Summary 240

9 The World of Health Care: Places, Procedures, and People 241Seeking Medical Care 242Perceiving Symptoms 242Interpreting Symptoms 244Seeking Help from the Health Care System 245Delaying Medical Care 245The Hospital 247A Hospital Patient’s Loss of Control 248Patient-Centred Care: An Ideal in the Hospital 253Spending Time in Hospital 253The Emergency Department 253Recovering from Surgery 254The Intensive Care Unit 255Discharge 259Palliative Care 260The Psychological Impact of Medical Procedures 261The Psychology of Colonoscopy 261The Psychology of Mammography 262People 263Physicians 264Physicians’ Emotional Involvement in Their Work 264Physicians and Stress 265Gender Issues in Medical Practice 268Nurses 270The Nature of Modern Nursing 270Stress in Nursing 272Others 274Physiotherapists 274Chapter Summary 277

Part 3 Bigger Pictures: The Health of Populations

10 From One to Many: Health on a Large Scale 279The Social Ecological Model: Building on the Biopsychosocial Approach to Understand Big Pictures 280

Tracking Health and Illness at the Population Level 282Social Determinants of Health in Canada 283The Vulnerability of Populations 284Culture and Health 287What Is Culture? 288How Culture Affects Health 289What Is Required to Ensure the Best Possible Health for All, Regardless of Culture? 290The Health of Canada’s Aboriginal Peoples 291Who Are Canada’s Aboriginal Peoples? 291Health Challenges 292Addressing the Challenges 293Harm Reduction as a Treating and Preventing Illness at the Population Level 294Reducing the Harm of Injection Drug Use 295The Psychology of Vaccination 296Health and the Built Environment 298Chapter Summary 300

11 Health Promotion 302Canada as a Worldwide Leader in Health Promotion 304The Goals of Health Promotion in Canada 306Health Promotion Mechanisms 307Using Psychological Principles to Promote Healthy Living 310Prominent Theories in Health Psychology Applied to Health Promotion 310The Social Psychology of Health Promotion 311Look Before You Leap: The Precede-Proceed Model 317Assessing the Effectiveness of Health Promotion Programs 319A Final Word about Health Promotion 321Chapter Summary 321

Focused Modules FM-1

Glossary 323

References 333

Index 395


x

Preface

With each new edition of The Psychology of Health and Health Care: A Canadian Perspective, we as authors learn more and more about this fascinating field of health psychology. In writing this fifth edition, we have reinforced our belief that the field continues to mature and expand, learning from other branches of psychology and from other disciplines.

As learners and as authors, we continue to feel very fortunate to be able to work in a country in which issues, opinions, and data are so very accessible. In the late 1990s, when we first began conceptualizing this book, we were convinced that the topics of health psychology manifest themselves in unique ways in Canada. After writing this fifth edition, we hold fast to that conviction. While many psychological theories developed in the United States and elsewhere apply well internationally, it is still the case that, when it comes to health and health care, our geography, demography, history, and health care system make Canadians unique, even in the face of significant, though debated, reforms to the American health care system. Our experience in writing this edition continues to confirm that Canadians are very active in research that goes beyond descriptions of our health to explore the factors affecting it. Again, you will find hundreds of new references as this research is discussed throughout the book.

HOW BeST TO USe THIS BOOkThe fifth edition of The Psychology of Health and Health Care: A Canadian Perspective is organized into major parts and chapters. The division of topics into major parts is a new addition to the book. You will see that we are continuing to place the work of health psy-chology in larger disciplinary and societal contexts, especially in Part 3 entitled Bigger Pictures: The Health of Populations. Chapters continue to be the traditionally used organizational elements. This book presents topics that are commonly found in most health psychology textbooks. Stress and coping, health communication, pain, and chronic and life-threatening illnesses are examples of such topics. However, this edition also con-tains chapters on some topics that are often covered in less detail by other texts. Examples include psychoneuroimmunology, health promotion, and health and physical activity.

Instructors are invited to use the book’s chapters as they see fit for their educational context. For example, nursing and medical students may want to focus more on chapters such as Psychoneuroimmunology, Health Communication, The World of Health Care, Pain, and Chronic and Life-Threatening Illnesses.

Health psychology is essentially an applied discipline, and each chapter of our book opens with a vignette intended to provide students with a realistic context for what they are about to read. In this way, we begin each chapter with an applied focus. Students will also find case studies throughout the book. In addition to the analysis we provide, students can discuss these case studies in lectures and seminars.

WHAT’S NeW IN THe FIFTH edITIONThis fifth edition includes new features that highlight the key concepts for each chapter. We have rethought the structure of our “advance organizers” that help students start thinking about a chapter before delving into it. Correspondingly, we have restructured


xiP r e f a c e

our chapter reviews to enhance students’ recall and help them think about the material in deeper rather than surface ways.

The most noticeable expansion found in this fifth edition is Part 3: The Bigger Picture: The Health of Populations. The material in this section reflects health psycholo-gists’ growing appreciation for the interdisciplinary nature of their work—that no challenge in health can be understood solely from one perspective. The section also acknowledges that, while working with individuals is still a fundamental reality in health care, health is more dramatically improved by focusing on populations. No single health care practitioner can have as much impact as can one well-implemented and thoughtful policy on clear drinking water.

SUPPLeMeNTSThe following instructor supplements are available for downloading from a password- protected section of Pearson Canada’s online catalogue. Navigate to your book’s catalogue page to view a list of those supplements that are available. See your local Pearson sales representative for details and access.

Test Item File Available in Microsoft Word, the test bank includes a wide variety of questions that will help you create meaningful student tests and assessments.

PowerPoints The PowerPoint presentations highlight the key concepts in each chapter and will enhance classroom lectures and discussion.

CourseSmart for Instructors CourseSmart goes beyond traditional expectations—providing instant, online access to the textbooks and course materials you need at a lower cost for students. And even as students save money, you can save time and hassle with a digital eTextbook that allows you to search for the most relevant content at the very moment you need it. Whether it’s evaluating textbooks or creating lecture notes to help students with difficult concepts, CourseSmart can make life a little easier. See how when you visit http://instructors.coursesmart.com.

Learning Solutions Managers Pearson’s Learning Solutions Managers work with faculty and campus course designers to ensure that Pearson technology products, assessment tools, and online course materials are tailored to meet your specific needs. This highly qualified team is dedicated to helping schools take full advantage of a wide range of educational resources, by assisting in the integration of a variety of instructional mate-rials and media formats. Your local Pearson Education sales representative can provide you with more details on this service program.

Pearson Custom Library For enrollments of at least 25 students, you can create your own textbook by choosing the chapters that best suit your own course needs. To begin building your custom text, visit www.pearsoncustomlibrary.com. You may also work with a dedicated Pearson Custom editor to create your ideal text—publishing your own original content or mixing and matching Pearson content. Contact your local Pearson Representative to get started.

peerScholar Firmly grounded in published research, peerScholar is a powerful online pedagogical tool that helps develop students’ critical and creative thinking skills through creation, evaluation, and reflection. Working in stages, students begin by submitting


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written assignments. peerScholar then circulates their work for others to review, a process that can be anonymous or not, depending on instructors’ preferences. Students immedi-ately receive peer feedback and evaluations, reinforcing their learning and driving devel-opment of higher-order thinking skills. Students can then re-submit revised work, again depending on instructors’ preferences.

Contact your Pearson representative to learn more about peerScholar and the research behind it.


xiii

Acknowledgements

We are very grateful for the help we received from Sean Benay, who provided a very care-ful reading of our first edition, and from Caroline Murphy of the University of British Columbia, who pointed us in the right direction regarding the content for the focused module on Health and the Internet.

We also continue to be very grateful to Peter Gibson for sharing and updating his remarkable story with us in chapter 5. For their feedback on the first edition, we would also like to thank Lois Hunt and Dennis Krebs of Simon Fraser University, Tina Niwinska and Jody L. Bain of the University of Victoria, Kathleen A. Martin Ginis of McMaster University, Dean Tripp of Queen’s University, and Angie MacKewn of the University of New Brunswick.

Pearson Canada and the authors would like to thank the following individuals for their reviews during the development phase of this title: Judith Andersen, University of Toronto Mississauga; Theresa Bianco, Concordia University; Yves Bureau, Western University; Nukte Edguer, Brandon University; Kyoko Hattori, Carleton University; Cameron Muir, Brock University; and Randall Tonks, Camosun College.

Gary PooleDeborah Hunt Matheson

David N. Cox


xiv

About the Authors

Gary Poole is a Professor in the School of Population and Public Health in the University of British Columbia’s Faculty of Medicine. He received his Ph.D. in Psychology from Simon Fraser University. He has won numerous awards for his teaching, and he is Past President of the International Society for the Scholarship of Teaching and Learning. In addition to his publications in the area of health psychology, he is the co-author of “Effec-tive Teaching with Technology in Higher Education” (Bates, A.W., & Poole, G. (2003). Effective teaching with technology in higher education: Foundations for Success. San Francisco, CA: Jossey-Bass.)

Deborah Hunt Matheson is Chair of the Department of Psychology at Vancouver Island University. She received her B.A. (Hons) from Simon Fraser University and did her M.A. and Ph.D. graduate work at the University of Victoria. Her research interests are in health psychology, especially on factors that motivate people to commit to an exercise program. In addition, she is interested in communication in the medical setting. Her research has been published in journals such as Behavioral Medicine; the British Journal of Health Psy-chology; the Canadian Journal of Communication; the Journal of Nonverbal Behavior; the Journal of Sport and Exercise Psychology; Measurement in Physical Education and Exercise Science; Psychology and Health; Psychology, Health and Medicine; and the Psychology of Sport and Exercise.

David Cox is currently the Director of Clinical Training in the Department of Psychol-ogy at Simon Fraser University. He received his M.A. and Ph.D. from the University of British Columbia in Clinical Psychology. His research and applied interests currently focus on health psychology, human performance, and sport psychology. He is currently the Chair of the Sport Medicine Council of British Columbia. His most recent research has been published in journals such as the Journal of Clinical and Experimental Neuropsy-chology, the International Journal of Sports Physiology and Performance, the International Journal of Mental health and Addictions, the Journal of Pediatric Psychology, and the Journal of Adolescent Health.


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